Provider Demographics
NPI:1053662098
Name:HU, LIN CHYUAN
Entity Type:Individual
Prefix:
First Name:LIN
Middle Name:CHYUAN
Last Name:HU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17520 CASTLETON ST
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1701
Mailing Address - Country:US
Mailing Address - Phone:626-913-0042
Mailing Address - Fax:
Practice Address - Street 1:17520 CASTLETON ST
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1701
Practice Address - Country:US
Practice Address - Phone:626-913-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7611156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASL4298OtherREGISTERED SPECTACLE LENS DISPENSER MEDICAL BOARD OF CA
CAD7611OtherREGISTERED OPTICIAN DISPENSER